Washington State L&I Claims
The Washington Department of Labor and Industries (L&I) administers its own workers’ compensation benefits, either through a public State Fund (covering two-thirds of Washington State workers) or through self-insured employers (covering one-third of Washington State workers). Essentially, L&I is a state-run insurance company that provides benefits to workers who are injured at work or develop an occupational illness.
What Is An L&I Claim?
An L&I claim is a file of important information about a worker, their injury or exposure, their specific job, and their employer. An L&I claim is monitored and managed by an L&I Claim Manager who sees the process through from initial claim filing to closure. If all goes as planned, your claim is accepted by L&I and you will receive certain benefits.
How Does L&I Work?
When you get hurt or contract certain types of illnesses at work, you are entitled to workers’ compensation benefits. You can file an L&I claim in Washington State through the L&I website’s File Fast tool, by calling the L&I office at 877.561.3453, or at your doctor’s office.
Who Is Covered By L&I?
Virtually all employees in Washington State are covered by L&I workers’ compensation insurance. Two-thirds of Washington State workers are entitled to workers’ comp benefits through L&I. The remaining one-third of workers file claims directly through their self-insured employers. To determine whether you are covered by L&I or a self-insured employer, use the Find A Self-Insured Employer search tool on the L&I website.
What Qualifies As An L&I Claim?
L&I, or your self-insured employer, can approve your claim if your doctor certifies that you were injured at work, or have an occupational illness. If your claim is accepted by L&I you will receive certain benefits. Some of the benefits to which you may be entitled are medical care, time-loss, vocational rehabilitation, and L&I disability pensions for the most severely injured individuals. However, due to the bureaucratic nature of the claims process, many cases get bogged down in red tape, paperwork, and technicalities. An L&I claim could be denied for almost any reason including the following:
- The injury is considered preexisting.
- The injury is determined to have occurred outside of work.
- The injury occurred in a parking lot, which means it is not covered.
- The injury is a mental health condition and is denied due to a lack of objective medical evidence.
- An Independent Medical Exam (IME) diagnosis that determines the injury is not as bad as claimed, or non-existent.
How To File An L&I Claim In Washington State
In order to receive benefits from L&I there are two very important things that you must do right away, even before a claim is filed:
- Get medical help.
- Tell your employer.
If you are injured at work, you have three options to file a Washington State L&I claim:
- File by phone at 877.561.3453.
- File online through the L&I website’s File Fast tool.
- File at your doctor’s office.
Note that if you work with a self-insured employer, you must file your claim with them.
To file an L&I claim in Washington State, you must provide the following:
- The location where the injury occurred
- Contact information for any witnesses to the injury
- Employer information
- Wage information
- Names and birth dates of your dependents
- If you have already seen a doctor:
- Your doctor’s first and last name
- The hospital or clinic where you received treatment
If you are eligible for time-loss, and no further information is needed, L&I or your self-insured employer will send the first benefit check within 14 days of receiving the report. If your doctor is one of the many healthcare providers that do not handle workers’ compensation claim cases, you can find an L&I-approved doctor on the L&I website. If your L&I claim is approved, L&I will cover the initial visit even if it wasn’t with one of their approved doctors.
L&I or your self-insured employer must receive your Report of Accident within 1 year of your injury date to file a claim. Occupational illness claims must be received within two years from the date that your doctor notifies you in writing that your injury is work-related.
To determine the value of your L&I claim offered in Washington State. L&I settlements are paid out once the claim is closed, though the total settlement amount awarded upon claim closure depends on the size of the settlement. L&I settlement amounts vary widely and typically fall into three categories:
- 1. L&I Disability Pensions: a life-long pension awarded to injured workers who will never be able to return to gainful employment due to a severe or life-threatening injury.
- 2. Permanent Partial Disability (PPD) Awards: a one-time sum paid to injured workers when their L&I claim is closed. The worker can re-enter the workforce following a PPD award.
- 3. Claim Resolution Settlement Agreement (CRSA): an L&I settlement option where all parties agree to close an injury claim for a specified amount. When agreeing to this settlement type, the injured worker exchanges all future benefits, except medical, for the payment.
Your L&I Claim Is Worth More If You Also Have An Employment Law Claim Or Third-Party Claim
A significant number of L&I claims often involve additional legal claims such as employment law or third-party claims. Many people file their claims without seeking representation from an L&I lawyer, and thus never discover that in addition to their claim, they may be missing out on the ability to file an employment law claim or a third-party claim. Pursuing additional legal action has the potential to significantly increase their overall compensation.
Emery | Reddy, PLLC is the only law firm in Washington State that is equipped to provide comprehensive representation on your case from every angle. We thoroughly assess every case to determine if our clients have additional claims, at times this can extend far beyond the underlying workers’ compensation claim.
Common Claim Mistakes
L&I claim mistakes happen all too often. Some of the most common mistakes are the following:
Failure To File Your L&I Claim Promptly
If you want the best chance of receiving the L&I benefits you deserve, you need to report your injury and start the L&I claim process right away. You have one year from the date of your injury to file a claim for L&I benefits, or two years if the injury is an occupational illness. If you miss these deadlines, it’s very likely your claim will be permanently barred by these statutes of limitation.
Receiving An Unfavorable Independent Medical Exam (IME)
The purpose of an IME is to help the insurance company determine the reality and extent of your injury. The L&I doctor’s findings are then used to deny or award benefits for your workers’ compensation claim to help you recover and pay for treatment. Here are our tips on how to beat an IME exam and see past IME doctor tricks.
Downplaying Your Injury
Some workers downplay their injuries when they first see a doctor. However, if you don’t tell the doctor exactly what you are experiencing, the doctor’s records won’t reflect your injuries and pain, and L&I or your employer could use these records to later prove that:
- Your injuries and pain are less severe.
- You weren’t really injured at all.
- Your injuries are the result of something that happened outside of the workplace.
Avoid making some of the most common mistakes by being honest about your injuries and their impact on your life.
Forgetting That You Are Being Monitored
From the moment you are injured at work, you should expect to be monitored. L&I defense firms regularly use surveillance companies to try to catch an injured worker doing physical activity that contradicts the L&I claim. IME staff and doctors also look for any sign that an injured worker could be overplaying an injury. Defense counsel has been known to hire investigators to research and record social media posts and online activity. Employers are incentivized to use resources to fight an L&I claim because accepted claims affect the amount they pay for workers’ comp insurance.
Refusing Work Offered By Your Employer After Filing Your L&I Claim
In most circumstances, you should not outright refuse an offer for light-duty work. You may find that you can cope with light-duty work if it’s pitched at an appropriate level. If you find yourself in this situation, the first thing you should do is call the legal team at Emery | Reddy, PLLC immediately. The second thing you should do is contact your doctor. If your doctor disagrees with the light-duty job in writing, you will have a good argument to L&I that you remain unable to work.
Waiting To Protest Or Appeal Your L&I Claim
You, your employer, and your doctor all have the right to protest any decision made about your claim. L&I must receive a written protest within 60 calendar days of the date the decision was received (15 days for decisions about vocational benefits) or the decision will become final.
You may also appeal directly to the Board of Industrial Insurance Appeals (BIIA). The decision becomes final if your written appeal is not received within the following legal time limits from the date you received the decision:
- 60 days to appeal a claim decision or a payment decision
- 20 days for providers to appeal a billing decision that reduces the amount paid or demands repayment
Not Understanding Your Impairment Rating
For many L&I claims an impairment rating is issued, which determines how much an injured worker will get paid based on their injury and the effect it has on their daily life. It is important to understand the answers to the following questions:
- Who issued the rating?
- Did the IME provide the rating?
- Which doctors support the rating?
It is important that you have the right medical opinion and support to ensure that you receive the highest rating available.
Not Realizing That Mental Health Issues Are Valid L&I Claims
Mental health issues are treated similarly to physical injuries when they occur in the workplace; however, it’s not easy to find a mental health professional capable of supporting a mental health L&I claim. One of the biggest issues with L&I claims involving mental health injuries stems from the injury itself—and if you find it difficult to address your L&I claim on your own, hiring one of the experienced L&I lawyers at Emery | Reddy immediately is crucial to receiving the benefits that you deserve.
Construction Site Claims
Work-related injuries and occupational illnesses are common occurrences in the construction industry, with injuries occurring at a higher-than-average rate for construction workers due to the following factors as stated by L&I:
- Heavy lifting, awkward postures, repetitive motion, overexertion, and other physical stressors
- Working at heights
- Confined spaces
- Hazardous chemicals and materials (e.g., silica dust, asbestos, lead fume or dust, solvent-based adhesives, carbon monoxide in exhaust gas from fuel-powered equipment)
- Heavy machinery and power tools with dangerous moving mechanical parts
- Flying debris and falling objects
- Harsh weather (e.g., heat, cold, wind)
- Slips, trips, and falls
Because of these dangers, much of what happens on a construction site has the potential to cause bodily and mental harm should something go wrong.
Reopen A Claim
If your workplace injury or occupational disease worsens, you and your doctor may apply to reopen your claim. There must be medical evidence from an L&I-approved provider stating that after your claim closed, the condition caused by the original workplace injury worsened and needs more medical attention.
The amount of time that you have to reopen your L&I claim depends on the benefits you are seeking:
- For medical treatment only, you may apply at any time.
- For both wage replacement benefits and medical treatment, apply within 7 years of the date your claim was first closed (10 years for eye injuries).
- If your claim has been closed for more than 7 years, you may apply for medical benefits. However, only the L&I Director may grant additional disability benefits such as wage replacement or disability awards for these claims.
Self-Insured Employer Claims
Self-insured employers account for one-third of workers’ compensation in Washington State, and they provide benefits directly to injured workers. Self-insurance is less common than L&I insurance, but it’s quite popular among larger corporations, as self-insured policies allow the company to save money.
If injured by a third-party in Washington State, workers cannot sue their employer for compensation. However, when injuries are caused by defective products or machinery, or by someone who is not a co-worker, you may be able to file a third-party claim to cover the costs of your injury.
What Is A Third-Party Claim?
A third-party claim is one in which someone other than your employer or co-worker is responsible for your injury. If you have been injured on the job due to someone else’s actions or negligence, you may be entitled to additional compensation through a third-party claim, which combines your L&I claim with a personal injury claim using the same facts.
Unlike workers’ compensation payments, there is no limit to the amount of compensation an injured worker may seek in third-party damages.
Who Is At Fault For A Workplace Injury?
L&I is a no-fault system, ensuring compensation for any workplace injury. However, if a third-party is involved in causing the injury, you may be able to pursue legal action against them for additional compensation under third-party claims.
Closing Your L&I Claim
Your L&I claim closes when a physician certifies that further treatment will not improve your condition, meaning that you have met maximum medical improvement (MMI), or you have returned to work, or that L&I has determined that you are fit to return to work.
What Happens After Your L&I Claim Is Closed?
- If you do not protest or appeal, after 60 days the closing order becomes final.
- If you protest or appeal, then the closing order is held in abeyance. See Denied Claims
How Do I Know If I Have A Case?
The bottom line is that anyone who isn’t familiar with L&I claims in Washington State should seek the input of experienced L&I attorneys who do.
After years of helping injured workers, Emery | Reddy has recovered millions for our clients. Our team of L&I attorneys is experienced in litigating and L&I claims, injury law claims, and employment violations. We understand how to leverage each claim in state or federal court and before the Board of Industrial Insurance Appeals to maximize the value of all of your claims.
Emery | Reddy Can Help You With Your L&I Claim
Emery | Reddy is the only law firm in Washington State that is equipped to provide comprehensive representation on your case from every angle. We thoroughly assess every case to determine if our clients have additional claims, and at times this can extend far beyond the underlying workers’ compensation claim.
If you have been injured in the workplace call Emery | Reddy today to speak with our legal team for a free case review. Please remember to have your L&I claim number readily available.
Want More Information?
To determine the value of your L&I claim you first need to understand the different types of L&I settlements offered in Washington state.
The L&I workers’ compensation process is anything but straightforward. Find out the answers to your L&I workers’ comp questions today.
Self-insured employers account for one-third of workers’ compensation in Washington State, and they provide benefits directly to injured workers.
Meet The Team
The L&I attorneys at Emery | Reddy are passionate about helping workers with L&I claims and employment law issues. We Help Workers®: it’s our motto and what drives us every day.
We know how L&I and big companies think, and we understand the tactics they use. Our Seattle L&I attorneys use that knowledge coupled with over two decades of experience to help our clients get access to the L&I benefits to which they are legally entitled to and hold employers accountable when they break the law.
With our law office location in Seattle, we serve communities throughout the region, including Vancouver, Bellevue, Everett, Olympia, Shoreline, Spokane, and Tacoma. If you’re struggling with an L&I claim, injury, or legal issue at work, please call us and see how Emery | Reddy can help you today.
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